SPIRIT Project Summary Many suicide prevention interventions have demonstrated efficacy individually, but are not implemented or translated into meaningful care outcomes that can be implemented across multiple contexts. Researching the implementation process is a key to determine whether an integrated intervention is sustainable when implemented on a wider scale. This project aims to close the implementation gap by implementing an integrated suicide prevention intervention in a rural area of Gujarat and assess the success of the intervention in changing behavior of community recipients of the intervention leading to reduced suicides, suicidal behavior using RE-AIM framework. The second aim of the study is to train professionals to conduct implementation research and generate knowledge about key factors that enhance or hamper scaling-up our approach in order to make recommendations for spread to other regions and states in India and in the neighboring country of Bangladesh. A final aim of the project is to empower regional policy makers to integrate evidence generated from implemented research on suicide prevention in policy making in Gujarat. The project proposes that the integrated intervention will be implemented as a cluster randomized controlled trial, in one district (Mehesana) of the state of Gujarat, which has a population of about 2.03 million, with 74% of the district?s population classified as living in rural areas. The components of the intervention include (a) developing a complex multi-level, multi-disciplinary, multi-population suicide prevention intervention for the state of Gujarat (b) assess reach, effectiveness, adoption, and consistency and cost effectiveness of this intervention (c) train public health workers to conduct implementation research for recognizing suicidal ideation and behaviors, and in building the capacity of health workers to provide initial support, including strategies for building resilience and fostering coping strategies, and referring community members to services. The ultimate outcome is reduction in suicides and attempted suicides among adults and in addition, reduction in suicidal behavior among adolescents.